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Secure messaging Mailing (letter with acknowledgment of receipt) Pick up in person Do you wish be contacted by phone ? Oui Non You wish to be contacted between ? and Phone N° Your signed letter Your signed letter .pdf, .doc, .docx, .odt, .jpg, .jpeg, .png - Poids max : 3Mo Would you like to receive information on? The Membership Program Our Ongoing Projects Bequests, Donations and Life Insurance Your patient ID (NIPP) Attach a file Attach file .pdf, .doc, .docx, .odt, .jpg, .jpeg, .png - Poids max : 3Mo If any of the following situations apply to you, please tick the corresponding box Pregnant Pacemaker wearer Over 70 years old Child under 5 years old Avant de poursuivre : ce formulaire est destiné aux demandes de rendez-vous en radiologie, échographie, scanner, IRM et mammographie. Pour la médecine nucléaire, merci de contacter directement le service à l’adresse suivante : nucleaire@ahparis.org. Pour les explorations fonctionnelles, les rendez-vous sont à prendre directement sur Doctolib : https://www.american-hospital.org/nos-specialites/explorations-fonctionnelles Upload the prescription .pdf, .doc, .docx, .odt, .jpg, .jpeg, .png - Poids max : 3Mo Computing and Freedom --“By sending this form, I agree that my information will be used by the American Hospital of Paris to respond to my request. My data is processed in accordance with the Privacy Policy. In accordance with the modified data protection act of January 6, 1978, I can exercise the rights of access, rectification, deletion and portability on my data by writing to [dpo@ahparis.org] with proof of identity. »* American Hospital of Paris 63 Boulevard Victor Hugo Neuilly-sur-Seine, France 92200 +33146412525
